Provider Demographics
NPI:1992321137
Name:PALLERINE, MARE (DNP, ARNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MARE
Middle Name:
Last Name:PALLERINE
Suffix:
Gender:F
Credentials:DNP, ARNP, PMHNP-BC
Other - Prefix:
Other - First Name:MARIANA
Other - Middle Name:
Other - Last Name:NIBLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4311
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-0032
Mailing Address - Country:US
Mailing Address - Phone:360-240-4000
Mailing Address - Fax:
Practice Address - Street 1:275 SE CABOT DR STE B101
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3740
Practice Address - Country:US
Practice Address - Phone:603-675-6648
Practice Address - Fax:603-679-9310
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61311630363L00000X, 363LP0808X, 363LP0808X
UT8590046-3102363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty